Background <p>Hospital falls can cause major injuries such as fractures or brain injuries. This study aimed to investigate the prevalence of major injuries and associated factors in geriatric patients who sustained in-hospital falls and to compare them with those in non-geriatric patients.</p> Methods <p>This retrospective cohort study was conducted at a single tertiary hospital. Consecutive patients who sustained in-hospital falls over a 1-year period were included in the study. All patients were classified into the geriatric (≥ 65 years) or non-geriatric (&lt; 65 years) groups. Demographics, fall characteristics, injury severity, treatments after fall-related injuries, and length of stay were compared between the two groups.</p> Results <p>A total of 190 patients were included, with 105 in the geriatric group and 85 in the non-geriatric group. The proportion of patients at high risk of falling was significantly higher in the geriatric group (97.1% vs. 82.4%, <i>P</i> &lt; 0.001). There were no significant intergroup differences in terms of level of consciousness, level of assistance, type of walking aid, Morse Fall Scale, or overall medication-related fall risk score. Major injuries after falls occurred in 9.5% of the geriatric group and 1.2% of the non-geriatric group (<i>P</i> = 0.009). In the geriatric group, 70% of the major injuries were fractures. The average length of stay and time from admission to fall occurrence did not differ significantly between the groups.</p> Conclusions <p>Geriatric patients were approximately eight times more likely to experience major injuries after in-hospital falls than non-geriatric patients, with fractures being the most common major injury.</p>